Individual
COLLEEN MARY NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2801 W KINNICKINNIC RIVER PKWY, SUITE 730, MILWAUKEE, WI 53215-3669
(414) 649-7202
(414) 649-5158
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(414) 649-7202
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
34547-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32136100
—
WI
01
—
34547-020
LICENSE
WI
01
—
RAILROAD MEDICARE
110232521
WI
Enumeration date
12/05/2005
Last updated
07/21/2024
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